SJLA_2024_A7: Five Cases of Salvage Thoracoscopic Esophagectomy after Proton Beam Therapy

Abstract

Introduction: Proton beam therapy (PBT) has the feature of reducing radiation exposure to surrounding organs compared to conventional X-ray irradiation, so PBT for esophageal cancer is gradually spreading. Background: However, there are few reports about salvage esophagectomy after PBT, and its efficacy and safety are unclear. Methods: We reviewed the clinical and surgical outcomes of 5 cases who underwent salvage thoracoscopic esophagectomy after PBT from 2010 to 2023. Results: Four of five cases were males; the median age was 70 years, and all lesions were in the thoracic esophagus. One case was T2 lesion depth before PBT and 4 cases were T3. The median dose of proton beam radiation was 35.2 (26–60) Gy, and the median total (including X-ray) radiation dose was 66 (40–71.2) Gy. For of them were recurrent and one was remnant lesions. All cases were performed through thoracoscopic esophagectomy (one was converted to open surgery). Median thoracic operation time and blood loss were 217 (213–427) min and 10 (6–565) ml, respectively. Two cases with a preoperative diagnosis of T1-2 showed fibrosis comparable to that seen in conventional salvage esophagectomy, and we underwent R0 resection. However, the others had severe fibrosis and Grade IIIb postoperative complications such as thoracic abscess and cardiac tamponade requiring open chest drainage, and percutaneous pericardial drainage was occurred in two cases who underwent R2 resection. Discussion: For the nonlocally advanced cases, the results were comparable to the conventional salvage esophagectomy. However, fibrosis and scarring of the irradiated area were stronger after PBT, especially in advanced lesions, and they were at high risk for non-R0 resection and complications. Conclusion: Because the number of cases was small in this study, it is necessary to conduct further studies on a large number of cases, including multicenter collaboration.